HEALTH CARE BRIEFING: Trump Leaves Health Debates to Congress

President Donald Trump signed an executive order intended to pressure Republican lawmakers, who have long been unable to put together an Obamacare alternative, to develop a plan to protect people with pre-existing health conditions.

Trump has often promised he would produce a replacement for the Affordable Care Act, which guarantees health insurers can’t deny coverage to sick people or charge them more. Just last week, the president said his plan is “ready.” But the order essentially abandons the issue to Congress, suggesting he won’t offer his own plan before the election.

The order will direct Health and Human Services Secretary Alex Azar to work with lawmakers in addressing “surprise” hospital billings, Azar said in a briefing. The measure comes as Trump faces Democratic criticism he’s failed to offer a replacement for the Affordable Care Act now facing a U.S. Supreme Court challenge.

While Azar said the president’s order would make it the U.S.’s policy that people with pre-existing conditions can’t be denied insurance or made to pay more, he didn’t address what the administration could do about this without a law being passed and signed.

Yesterday’s speech and accompanying orders laid out Trump’s broader vision for U.S. health care in a second term. Trump emphasized bolstering consumer choice, affordability, and quality of health care for vulnerable groups. And the president portrayed previous actions he’s taken to reduce drug costs, expand tele-medicine, and assist vulnerable groups like people with kidney disease as indicative of his agenda towards a more ambitious overhaul. Read more from John Tozzi, Jacquie Lee and Justin Sink.

The Road Ahead in Congress: But even as Trump wants Congress to take on curbing surprise medical bills and enshrining insurance pre-existing condition protections, lawmakers remain split on both issues, with only four legislative days left for the House before the Nov. 3 election, Alex Ruoff reports.

Republican leaders were quick to praise Trump’s call to action, but Democrats said the White House hasn’t worked with key lawmakers in the House to spur action on legislation. A senior House Democratic aide said HHS hasn’t reached out to Speaker Nancy Pelosi (D-Calif.) about either issue.

House Majority Leader Steny Hoyer (D-Md.) said in a statement an executive order cannot preserve the ACA from a Supreme Court strike down, and legislation would be needed. But “Republicans in Congress voted more than sixty-five times to repeal or undermine the Affordable Care Act and its protections for those with pre-existing conditions,” Hoyer said.

Democratic leaders also haven’t been able to strike an agreement on a surprise billing deal since Ways and Means Chairman Richard Neal (D-Mass.) opposed a bipartisan deal stuck by the chairmen of the House and Senate’s health panels.

Lamar Alexander (R-Tenn.), who chairs the Senate Health, Education, Labor and Pensions Committee, said in a statement yesterday that Trump was “right to call on Congress” to act on surprise medical billing. Alexander struck a deal with House Energy and Commerce Chairman Frank Pallone (D-N.J.) on surprise bills last year, but they haven’t been able to win over Neal yet.

“Ending surprise medical bills is a problem that requires a permanent solution passed by Congress this year,” said Alexander, who plans to retire in 2021. But Neal, Pallone and House Education and Labor Chairman Bobby Scott (D-Va.) called Trump’s executive order a “shameless election year stunt.”

The Coronavirus Pandemic

Pelosi-Mnuchin Stimulus Buzz Masks Deep Divide to Getting a Deal: A last-ditch attempt by Democrats and the White House to restart negotiations on a new stimulus drew skepticism in Congress that a deal could be reached and written into law by Election Day. Both sides had largely given up on stimulus talks after a weeks-long stalemate, even amid signs of strain in financial markets. But Thursday brought a flurry of activity that suggested movement on virus relief efforts as the clock runs out for Congress.

House Speaker Nancy Pelosi (D-Calif.) and Treasury Secretary Steven Mnuchin expressed willingness Thursday to resume talks that broke off in August. Separately, House Democrats started work on what would be a roughly $2.4 trillion stimulus proposal that they could take into negotiations.

The new Democratic plan is roughly in line with the last offer made by Pelosi and Senate Minority Leader Chuck Schumer (D-N.Y.) to Mnuchin and White House Chief of Staff Mark Meadows, which the administration rejected. Smaller than the $3.4 trillion package the House passed in May, it’s still more than the $1.5 trillion President Donald Trump has indicated he would accept, and much bigger than the $650 billion in new spending supported by Senate Republicans.

Representative Kevin Brady (Texas), the top Republican on the tax writing committee, called the move to draft a Democrat-only bill “a waste of time.” Read more from Erik Wasson and Billy House.

Panel Asks IG to Probe Interference at CDC: House Energy and Commerce Chairman Frank Pallone (D-N.J.), and the chairwomen of the health and oversight panels, Reps. Anna Eshoo (Calif.) and Diana DeGette (Colo.), requested the HHS inspector general investigate potential political interference “by the White House and Trump Administration political appointees into the scientific work of employees” at the CDC, according to an emailed statement. Read the letter here.

Vaccine Chief Stocks Defended: The Health and Human Services Department defended former GlaxoSmithKline executive Moncef Slaoui’s decision to retain millions of dollars in stocks in the pharmaceutical giant as he leads the Trump administration’s push to accelerate coronavirus vaccines. In a letter sent earlier this week to the House Select Subcommittee on the Coronavirus Crisis , HHS Assistant Secretary for Legislation Sarah Arbes said Slaoui has “taken steps well beyond those required of him by law” to mitigate conflicts of interest. Read more from Jeannie Baumann.

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What Else to Know

Lost Year Looms for Research in Stopgap: Young scientists could drop out of medical research and biomedical progress could derail for several years due to spending restrictions imposed on the NIH as part of stopgap funding measures. The Senate is expected to take up next week a spending bill (H.R. 8337) to keep the government operating through Dec. 11. While the continuing resolution will keep the government open, the National Institutes of Health cannot initiate any new projects and may reduce existing grants until Congress passes a final labor-health and human services spending bill.

“They don’t know how much money they have to work with, so they are going to be very conservative and reduce the size of grants to provide contingency funds in case their budget is cut,” said Ellie Dehoney, Research!America vice president of public policy and programs. Jeannie Baumann has more.

  • The Senate voted 93-2 yesterday to proceed to consideration of a continuing resolution (H.R. 8337) to fund the government through Dec. 11. Senate Majority Leader Mitch McConnell (R-Ky.) filed for cloture yesterday before members left town. They’ll return Tuesday to vote that evening to end debate, and they have yet to schedule a vote on passage. Funding is set to run out at midnight Wednesday night, Jack Fitzpatrick reports.

Trump Says Elderly to Get $200 for Drugs: Trump also said yesterday that Americans in the Medicare health-care program for the elderly and disabled will be sent $200 discount cards for prescription medication as the election nears. “The cards will be mailed out in coming weeks,” he said. It wasn’t immediately clear who would pay for the cards or under what authority Trump’s administration was providing them. If they’re sent to all 33 million Medicare participants, the cards would cost roughly $6.6 billion. Justin Sink and Jordan Fabian has more.

  • Meanwhile, the U.S. will import some medications from Canada in order to keep prescription prices down, the Food and Drug Administration announced yesterday. The final rule allows states, tribes, pharmacists, and wholesalers to submit plans to the FDA to import medications provided they can demonstrate the moves would save patients money. Read more from Andrew Childers.

Ginsburg’s Death Threatens Biosimilars: The system that allows for low-cost versions of biologic drugs is at risk of being eliminated if Obamacare is reversed in the wake of Ruth Bader Ginsburg’s death. The Affordable Care Act created a pathway for companies to make biosimilars—generic versions of biologic drugs that are very similar, although not identical, to the originals—without having to jump through costly hoops associated with getting a novel medicine approved. Read more from Valerie Bauman.

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With assistance from Jack Fitzpatrick

To contact the reporters on this story: Alex Ruoff in Washington at aruoff@bgov.com; Brandon Lee in Washington at blee@bgov.com

To contact the editors responsible for this story: Zachary Sherwood at zsherwood@bgov.com; Giuseppe Macri at gmacri@bgov.com; Michaela Ross at mross@bgov.com

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